Lower health subsidies expected in 3 AZ counties

In this Dec. 3, 2013 photo, actor Adrienne Matzen poses in Chicago’s theater district. Matzen, 29, who has been mostly uninsured since she turned 21, is now looking for a low monthly premium insurance plan on the federal website. High deductibles for health plans available on the Illinois insurance exchange may contribute to sticker shock when people start paying medical bills in 2014, if they have elected to pay for insurance under the Affordable Care Act. (AP Photo/M. Spencer Green, File)

People living in Pima, Maricopa and Pinal counties are expected to get less help paying for health insurance compared with most consumers in the 36 states that use the federal marketplace created under the nation’s new health care law.

The calculations used to determine subsidies, which are based on a person’s income and a community’s lowest cost health policies, are driven in Arizona by a single insurer that charges much less than other companies, an analysis by The Arizona Republic found.

There could be a significant difference in the amount Arizonans collect vs. consumers in other states. A non-smoking 27-year-old Tucson resident who earns $25,000 a year won’t get any subsidy. But a person of the same age and income in Cheyenne, Wyo., qualifies for $2,154 per year, according to Value Penguin, a consumer information website.

The most someone can earn and still collect a subsidy is 400 percent of the federal poverty level — $45,960 for an individual or $94,200 for a family of four. But many Arizona consumers who earn less won’t qualify. That’s because the subsidies vary between counties and are calculated not just on income but also on the cost of a community’s “benchmark” health insurance plan, which is the second least expensive plan sold.

In Pima, Maricopa and Pinal counties, the benchmark plans are sold by Woodland Hills, Calif.-based Health Net and are among the cheapest across the federal marketplace. The nation’s least expensive overall is Pima County’s benchmark plan, which charges $138 per month for a 27-year-old non-smoker. That means Pima County residents will get the least generous subsidies among all communities in the federal marketplace.

In Maricopa and Pinal counties, the benchmark plans charge $161 and $162 per month, respectively, for a non-smoker of the same age.

Maricopa County was ranked the 70th cheapest among the more than 2,500 counties in the federal marketplace. Pinal County was 71st cheapest. The analysis does not include plans in states that are operating their own marketplaces.

Despite lower subsidies, Arizonans may be eligible for other assistance. For example, a person who earns less than $28,725 will pay lower deductibles and less out of pocket under a provision that limits cost-sharing for those who earn less than 250 percent of the federal poverty level.